Systems and methods for healthcare service delivery location relationship management

ABSTRACT

Certain examples provide systems, apparatus, and methods for content-driven healthcare location relationship management. An example method includes receiving one or more location identifiers for a content-based clinical application. The example method includes assigning one or more locations to a source role and a target role based on the one or more location identifiers and an ontology, the ontology including a plurality of relationship types. The example method includes identifying a relationship between the source role and the target role based on the one or more location identifiers and the ontology. The example method includes associating the source role and target role based on the identified relationship. The example method includes utilizing the source role, target role, and identified relationship to configure one or more content items forming the content-based clinical application.

CROSS-REFERENCE TO RELATED APPLICATIONS

This patent claims priority to U.S. Provisional Application Ser. No.61/444,994, entitled “Systems and Methods for Healthcare ServiceDelivery Location Relationship Management,” which was filed on Feb. 21,2011 and is hereby incorporated herein by reference in its entirety.

FIELD OF THE DISCLOSURE

The present disclosure relates generally to healthcare informationsystems and, more particularly, to methods and apparatus forcontent-driven systems and methods.

BACKGROUND

Healthcare environments, such as hospitals and clinics, typicallyinclude information systems (e.g., electronic medical record (EMR)systems, lab information systems, outpatient and inpatient systems,hospital information systems (HIS), radiology information systems (RIS),storage systems, picture archiving and communication systems (PACS),etc.) to manage clinical information such as, for example, patientmedical histories, imaging data, test results, diagnosis information,management information, financial information, and/or schedulinginformation. These healthcare information systems are used to implementdifferent types of workflows in which clinical information is generated,updated, augmented, and/or otherwise processed for one or more purposes.

BRIEF DESCRIPTION

Certain examples provide systems, methods, and apparatus forcontent-based healthcare location management.

Certain examples provide a content-based healthcare location managementsystem including a correlation services manager to receive a locationcorrelation identifier and correlate the location correlation identifierwith an associated location instance identifier based on an ontology.The location instance identifier is to identify an internal instance ofthe location correlation identifier to provide location informationaccording to a location schema. The example system includes a locationservices manager to update a location map using the location instanceidentifier. The location services manager is to store the locationinstance identifier in a location relationship object based on at leastone relationship associated with the location instance identifier. Theexample system includes a frame manager to utilize the locationrelationship object to configure one or more content items forming aclinical application based on the location and relationship identifiedin the location relationship object.

Certain examples provide a tangible computer-readable storage mediumincluding computer program code to be executed by a processor, thecomputer program code, when executed, implementing a content-basedhealthcare location management system. The example system includes acorrelation services manager to receive a location correlationidentifier and correlate the location correlation identifier with anassociated location instance identifier based on an ontology. Thelocation instance identifier is to identify an internal instance of thelocation correlation identifier to provide location informationaccording to a location schema. The example system includes a locationservices manager to update a location map using the location instanceidentifier. The location services manager is to store the locationinstance identifier in a location relationship object based on at leastone relationship associated with the location instance identifier. Theexample system includes a frame manager to utilize the locationrelationship object to configure one or more content items forming aclinical application based on the location and relationship identifiedin the location relationship object.

Certain examples provide a method for content-driven healthcare locationrelationship management. The example method includes receiving one ormore location identifiers for a content-based clinical application. Theexample method includes assigning one or more locations to a source roleand a target role based on the one or more location identifiers and anontology, the ontology including a plurality of relationship types. Theexample method includes identifying a relationship between the sourcerole and the target role based on the one or more location identifiersand the ontology. The example method includes associating the sourcerole and target role based on the identified relationship. The examplemethod includes utilizing the source role, target role, and identifiedrelationship to configure one or more content items forming thecontent-based clinical application.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram of an example healthcare environment in whichthe example methods, apparatus, systems, and/or articles of manufacturedisclosed herein for clinical content-based healthcare may beimplemented.

FIG. 2 illustrates an example clinical knowledge system providing anaggregation of data from multiple sources.

FIG. 3 illustrates an example interdependence of content types.

FIG. 4 illustrates an example hierarchy of content, associated datamodels, and terminology.

FIG. 5 shows an example root content item having one or more contentvariants, which may be associated with one or more context variants.

FIG. 6 provides an example multi-patient view (MPV) including aplurality of formlets and a frameset.

FIG. 7 illustrates an example content management process.

FIG. 8 shows a deployment example including a plurality of models in acontent package deployed to create a content frame.

FIG. 9 provides an example of namespaces A, B, and C including variouscontent items (CIs).

FIG. 10 depicts an example of a state versus a workflow.

FIG. 11 illustrates an example clinical information system including areference platform and one or more content items that define clinicalfunctionality.

FIG. 12 shows an example directed acyclic graph used to provide alocation relationship ontology.

FIG. 13 depicts an example location correlation identification (CID)schema.

FIG. 14 depicts an example sequence diagram showing interaction betweenvarious components for location correlation.

FIG. 15 illustrates an example location service application programminginterface (API).

FIG. 16 illustrates a flow diagram for an example method of locationrelationship management in a content-based clinical system.

FIG. 17 is a block diagram of an example processor system that may beused to implement the systems, apparatus and methods described herein.

The foregoing summary, as well as the following detailed description ofcertain implementations of the methods, apparatus, systems, and/orarticles of manufacture described herein, will be better understood whenread in conjunction with the appended drawings. It should be understood,however, that the methods, apparatus, systems, and/or articles ofmanufacture described herein are not limited to the arrangements andinstrumentality shown in the attached drawings.

DETAILED DESCRIPTION

Although the following discloses example methods, apparatus, systems,and articles of manufacture including, among other components, firmwareand/or software executed on hardware, it should be noted that suchmethods, apparatus, systems, and/or articles of manufacture are merelyillustrative and should not be considered as limiting. For example, itis contemplated that any or all of these firmware, hardware, and/orsoftware components could be embodied exclusively in hardware,exclusively in software, exclusively in firmware, or in any combinationof hardware, software, and/or firmware. Accordingly, while the followingdescribes example methods, apparatus, systems, and/or articles ofmanufacture, the examples provided are not the only way(s) to implementsuch methods, apparatus, systems, and/or articles of manufacture.

Locations are an integral part of a healthcare delivery managementsystem. Location management has a profound impact on overall healthcaredelivery management. Location not only has geographical annotations butalso has usage context based annotations that relates to a role playedby a location in an association with another location. Locations sharerelationship based upon the organizational needs of a healthcaredelivery enterprise. A relation among various locations may befacilitated using a location type and a relationship among locationtype(s) and/or roles played by a location. Locations are used by theirtypes as well as well as their relation among the location type. Usingtypes and relations, a single location may play multiple roles andparticipate in multiple locations. A relationship among various types oflocations is hierarchical in nature and may be represented as anontology of location types.

Certain examples provide systems and methods to handle locationrelationship management for a clinical knowledge platform (e.g., GE'sQualibria®) and associated clinical information system(s) and method(s).Certain examples provide a source location, target location, locationrelationship, and rule/ontology definition. Locations and locationrelationships may be provided as clinical element instance objects, andan ontology definition may be provided as a terminology concept.Location and location relationship may be updated independently and arelationship between two locations may be created and updatedindependently in runtime, for example.

Certain examples leverage a Clinical Element Model (CEM), where locationand location relationship are clinical elements and may be modeled byeach healthcare delivery organization to suit their specific needswithout requiring changes in software. Locations are loaded into thesystem as independent entities, and one or more location relations arecreated to connect locations in a desired relationship ontology.

In certain examples, a location plays a source role or target role andis stored in a location relationship object. Allowed relationshipsbetween source and target roles are determined by the terminologydefinition of the ontology. Location relationship management servicesvalidate conflict of roles between locations and/or by location, forexample.

In certain examples, location relationships may be established as ahealthcare delivery organization changes/grows/reorganizes withoutimpacting existing software infrastructure of its location(s). Thesenewly added relationships may be made part of the system just in time orto be specific in realtime subject to availability of the terminology,for example.

After patient and encounter information, location information is animportant entity in a healthcare delivery management system. Locationrelationship is hierarchical in nature and ties locations with eachother. However, healthcare organizations undergo frequent changes forcare delivery management, financial management, research, teaching etc.This requires establishing a new relationship and changing the oldrelationship in realtime without stopping the working software of aHealthcare Delivery Management System, which would impact patienthealthcare.

Certain examples provide an approach for location relationshipmanagement to solve a creation, update and modification of relationshipproblem and make it possible to do in real time (or at leastsubstantially real time accounting for some system delay). Certainexamples avoid tying location relationship information with location,which would make it difficult to change later in real time, for example.

Entities of healthcare enterprises operate according to a plurality ofclinical workflows. Clinical workflows are typically defined to includeone or more steps or actions to be taken in response to one or moreevents and/or according to a schedule. Events may include receiving ahealthcare message associated with one or more aspects of a clinicalrecord, opening a record(s) for new patient(s), receiving a transferredpatient, and/or any other instance and/or situation that requires ordictates responsive action or processing. The actions or steps of aclinical workflow may include placing an order for one or more clinicaltests, scheduling a procedure, requesting certain information tosupplement a received healthcare record, retrieving additionalinformation associated with a patient, providing instructions to apatient and/or a healthcare practitioner associated with the treatmentof the patient, and/or any other action useful in processing healthcareinformation. The defined clinical workflows can include manual actionsor steps to be taken by, for example, an administrator or practitioner,electronic actions or steps to be taken by a system or device, and/or acombination of manual and electronic action(s) or step(s). While oneentity of a healthcare enterprise may define a clinical workflow for acertain event in a first manner, a second entity of the healthcareenterprise may define a clinical workflow of that event in a second,different manner. In other words, different healthcare entities maytreat or respond to the same event or circumstance in differentfashions. Differences in workflow approaches may arise from varyingpreferences, capabilities, requirements or obligations, standards,protocols, etc. among the different healthcare entities.

However, the entities of a healthcare enterprise and/or entities fromseparate healthcare enterprises sometimes operate within a broader,interdependent information system, which hinder the ability of entitiesto customize clinical workflows. For example, the information system towhich a healthcare entity belongs may place restrictions on changes toworkflow applications or programs. Moreover, because some healthcareentities operate using systems, programs, devices, etc. from varyingmanufacturers, software providers, etc., a lack of interoperabilitybetween the systems, programs, devices, etc. of each healthcare entityprohibits many customizations from realization. As a consequence ofthese example factors as well as additional or alternative factors,healthcare entities that desire customized clinical workflows aretypically required to request such customizations from themanufacturers, software providers, etc. Furthermore, for suchcustomizations to implemented or integrated into a healthcareinformation system, a wide range of system-interrupting updates orre-releases occur within the information systems.

Certain examples provide a clinical knowledge platform that enableshealthcare institutions to improve performance, reduce cost, touch morepeople, and deliver better quality globally. In certain examples, theclinical knowledge platform enables healthcare delivery organizations toimprove performance against their quality targets, resulting in betterpatient care at a low, appropriate cost.

Certain examples facilitate better control over data. For example,certain example systems and methods enable care providers to accessreal-time patient information from existing healthcare informationtechnology (IT) systems together in one location and compare thisinformation against evidence-based best practices.

Certain examples facilitate better control over process. For example,certain example systems and methods provide condition- and role-specificpatient views enable a user to prioritize and coordinate care effortswith an institution's agreed upon practice standards and to moreeffectively apply resources.

Certain examples facilitate better control over outcomes. For example,certain example systems and methods provide patient dashboards thathighlight variations from desired practice standards and enable careproviders to identify most critical measures within the context ofperformance-based care.

Certain examples leverage existing IT investments to standardize andcentralize data across an organization. In certain examples, thisincludes accessing multiple systems from a single location, whileallowing greater data consistency across the systems and users.

In certain examples, an advanced Service-Oriented Architecture (SOA)with a modern technology stack helps provide robust interoperability,reliability, and performance. The example SOA includes a three-foldinteroperability strategy including a central repository (e.g., acentral repository built from Health Level Seven (HL7) transactions),services for working in federated environments, and visual integrationwith third-party applications. Certain examples provide portable contentenabling plug 'n play content exchange among healthcare organizations. Astandardized vocabulary using common standards (e.g., LOINC, SNOMED CT,RxNorm, FDB, ICD-9, ICD-10, etc.) is used for interoperability, forexample. Certain examples provide an intuitive user interface to helpminimize end-user training. Certain examples facilitate user-initiatedlaunching of third-party applications directly from a desktop interfaceto help provide a seamless workflow by sharing user, patient, and/orother contexts. Certain examples provide real-time (or at leastsubstantially real time assuming some system delay) patient data fromone or more IT systems and facilitate comparison(s) againstevidence-based best practices. Certain examples provide one or moredashboards for specific sets of patients. Dashboard(s) can be based oncondition, role, and/or other criteria to indicate variation(s) from adesired practice, for example.

Generally, the example methods, apparatus, systems, and/or articles ofmanufacture disclosed herein enable healthcare entities of an enterpriseclinical information system (ECIS) to dynamically customize one or moreclinical workflows. Among other functions and/or benefits, the ECISsupports healthcare practitioners in decision making processes byaggregating healthcare information across disparate enterprises and/orentities thereof and referencing collection(s) of data (e.g.,guidelines, recommendations related treatment and/or diagnosis, studies,histories, etc.) to automatically generate supportive information to becommunicated to one or more healthcare practitioners related to theaggregated healthcare information. While each entity operates inconnection with the ECIS that is administered by a provider thereof, theexamples disclosed herein enable each entity of operating in connectionwith the ECIS to originate and/or modify one or more clinical workflowswithout relying on the provider of the ECIS to do so on behalf of theentity. In other words, although a healthcare entity is part of the ECISand exchanges data with and via the ECIS, that entity can independentlycreate and/or manage its clinical workflows using the examples disclosedherein. Furthermore, the examples disclosed herein enable entities ofthe ECIS to deploy or initiate the customized workflows without havingto reboot or significantly interrupt the ECIS and/or the othercomponents, workflows, etc., thereof. The example methods, apparatus,systems, and/or articles of manufacture disclosed herein and theadvantages and/or benefits thereof are described in greater detail belowin connection with the figures.

FIG. 1 is a block diagram of an example healthcare environment 100 inwhich the example methods, apparatus, systems, and/or articles ofmanufacture disclosed herein for clinical content-based healthcare maybe implemented. The example healthcare environment 100 of FIG. 1includes a first hospital 102 having a plurality of entities operatingwithin and/or in association with the first hospital 102. In theillustrated example, the entities of the first hospital 102 include anoncology department 104, a cardiology department 106, an emergency roomsystem 108, a picture archiving and communication system (PACS) 110, aradiology information system (RIS) 112, and a laboratory informationsystem (LIS) 114. The oncology department 104 includes cancer-relatedhealthcare practitioners, staff and the devices or systems that supportoncology practices and treatments. Similarly, the cardiology department106 includes cardiology-related healthcare practitioners, staff and thedevices and/or systems that support cardiology practices and treatments.Notably, the example oncology department 104 of FIG. 1 has specificallydesigned clinical workflows to be executed in response to certain eventsand/or according to a schedule. At the same time, the example cardiologydepartment 106 of FIG. 1 has specifically designed clinical workflows tobe executed in response to certain events and/or according to a schedulethat differ from the clinical workflows of the example oncologydepartment 104 of FIG. 1. For example, the oncology department 104 mayexecute a first set of actions in response to receiving a HealthcareLevel 7 (HL7) admission-discharge-transfer (ADT) message, while thecardiology department 106 executes a second set of actions differentfrom the first set of actions in response to receiving a HL7 ADTmessage. Such differences may also exist between the emergency room 108,the PACS 110, the RIS 112 and/or the accounting services 114.

Briefly, the emergency room system 108 manages information related tothe emergency care of patients presenting at an emergency room of thehospital 102, such as admission information, observations from emergencyexaminations of patients, treatments provided in the emergency roomsetting, etc. The PACS 110 stores medical images (e.g., x-rays, scans,three-dimensional renderings, etc.) as, for example, digital images in adatabase or registry. Images are stored in the PACS 110 by healthcarepractitioners (e.g., imaging technicians, physicians, radiologists)after a medical imaging of a patient and/or are automaticallytransmitted from medical imaging devices to the PACS 110 for storage.The RIS 112 stores data related to radiology practices such as, forexample, radiology reports, messages, warnings, alerts, patientscheduling information, patient demographic data, patient trackinginformation, and/or physician and patient status monitors, as well asenables exam order entry (e.g., ordering an x-ray of a patient) andimage and film tracking (e.g., tracking identities of one or more peoplethat have checked out a film). The lab information system 114 storesclinical information such as lab results, test scheduling information,corresponding practitioner(s), and/or other information related to theoperation(s) of one or more labs at the corresponding healthcarefacility. While example types of information are described above asbeing stored in certain elements of the hospital 102, different types ofhealthcare data may be stored in one or more of the entities 104-114, asthe entities 104-114 and the information listed above is included hereinas non-limiting examples. Further, the information stored in entities104-114 may overlap and/or be combined into one or more of the entities104-114. Each of the example entities 104-114 of FIG. 1 interacts withan electronic medical record (EMR) system 116. Generally, the EMR 116stores electronic copies of healthcare records associated with, forexample, the hospital 102 and the entities 104-114 thereof.

The example healthcare environment 100 of FIG. 1 also includes anoutpatient clinic 118 as an example of another healthcare enterprise.The example outpatient clinic 118 of FIG. 1 includes a lab informationsystem 120 and a PACS 122 that operate similarly to the correspondingentities of the example hospital 102. The lab information system 120 andthe PACS 122 of the example outpatient clinic 118 operate according tospecifically designed clinical workflows that differ between each otherand the clinical workflows of the entities 104-114 of the hospital 102.Thus, differences in clinical workflows can exist between the entitiesof a healthcare enterprise and between healthcare enterprises ingeneral.

In the illustrated example of FIG. 1, the hospital 102 and theoutpatient clinic 118 are in communication with an ECIS 124 via anetwork 126, which may be implemented by, for example, a wireless orwired Wide Area Network (WAN) such as a private network or the Internet,an intranet, a virtual private network, a wired or wireless Local AreaNetwork, etc. More generally, any of the coupling(s) described hereinmay be via a network. Additionally or alternatively, the examplehospital 102 and/or the example outpatient clinic 118 are incommunication with the example ECIS 124 via direct or dedicatedtransmission mediums 128 and 130.

Generally, the ECIS 124 supports healthcare information processingimplemented by systems, devices, applications, etc. of healthcareenterprises, such as the hospital 102 and the outpatient clinic 118. TheECIS 124 is capable of processing healthcare messages from differententities of healthcare enterprises (e.g., the entities 104-114 of thehospital 102) that may generate, process and/or transmit the healthcaremessages differently and/or using different formats, protocols,policies, terminology, etc. when generating, processing, and/ortransmitting the healthcare messages. Moreover, the example ECIS 124 ofFIG. 1 supports healthcare practitioners in decision making processes byaggregating healthcare information across disparate enterprises and/orentities thereof and referencing collection(s) of data to automaticallygenerate suggestive and/or definitive data for communication to one ormore healthcare practitioners related to the aggregated healthcareinformation.

Certain examples provide a library of standardized clinical content andproven best practices. Over time, this “library” of content may expandas healthcare organizations add to their own content modules. Becausethe content is standardized it can be shared and leveraged amongorganizations using the library and associated clinical knowledgeplatform. The library and platform help enable organizations to sharebest practice content. Thus, certain examples provide a clinicalknowledge platform that enables healthcare delivery organizations toimprove performance against their quality targets.

In certain examples, a quality dashboard application enables creation ofone or more dashboards based on the data/content most relevant to anorganization at a given period of time. A clinical knowledge platformbrings together real-time patient data from existing IT systems withinan organization and allows for the comparison of this data againstevidence-based best practices. The example quality dashboard applicationleverages the platform to enable personalized “Quality Dashboards” to becreated for specific sets of patients, based on condition, role, and/orother criteria. Variations from desired practice will be highlighted oneach dashboard, enabling care providers to ensure better clinicaloutcomes and enrich patient care.

In this example, the clinical knowledge platform aggregates data from anorganization's existing IT solutions. These can be solutions from thesame and/or different manufacturer and/or provider. For example, as longas there is an HL7 or Web Services feed, the clinical knowledge platformcan utilize the data from an existing solution. The existing ITsolution(s) will continue to operate as they always have, and anorganization can continue to use these solutions separate from theclinical knowledge platform if they so desire. However, the clinicalknowledge platform and associated application(s) and/or workflow(s) canhelp to put organizations in greater control of their data byaggregating as much data from disparate IT solutions as possible. FIG. 2illustrates an example clinical knowledge system 200 providing anaggregation 210 of data from multiple sources. Aggregated data mayinclude, for example, medication orders, radiology reports,microbiology, admit/discharge/transfer (ADT) message, lab results,specific observations, electronic medical record (EMR) data, etc.

As the different data sources are pulled into a central data repository,content standardization occurs. It is this “standardization” thatenables content from different IT sources to be used together. Forexample, as shown in FIG. 2, an interface 220 provides terminologymapping and standardization to the aggregated data.

After the content is standardized, clinical decision support mechanismscan be tied to the content (as illustrated, for example, by the clinicaldecision support 230 of the system 200 of FIG. 2). The data andassociated clinical decision support are then stored in a clinical datarepository (CDR), such as CDR 240 of the example system 200. Bycombining the aggregated and standardized data with clinical decisionsupport rules and alerts, the clinical knowledge platform may provideend-users with an understanding of important elements to which theyshould pay attention (and take action on) within the larger set of datathey are considering when caring for a patient.

Combined data and clinical decision support mechanisms create valuablecontent that, when arranged properly, may be used to improve the qualityof care provided. Organizations can elect to use the application(s) thatare provided as a part of the example clinical knowledge platform and/ormay choose to build their own clinical application(s) on the platform.The open architecture nature of the platform empowers organizations tobuild their own vision, rather than base their vision on the static/hardcoded nature of traditional IT solutions.

In certain examples, “Quality Dashboards” created via an exampleapplication display data via columns and rows in addition to individualpatient “inspector” views. For example, the system 200 shown in FIG. 2provides one or quality dashboards 250 to be created and personalized byan end user. The flexible nature of this dashboard application empowersorganizations to create dashboards of the aggregated data based on theirneeds at a given period of time. The organization may determine whatdata elements they would like to include on each dashboard and, withoutsignificant IT resources, create a dashboard that reflects their vision.In addition, organizations can determine where on the dashboard theywould like the information to be displayed and further adjust the viewof the content via features such as “bolding” font, etc. When data isadded to each dashboard, clinical decision support mechanisms attachedto this data are displayed on the dashboard as well. For example,content related to treating a patient based on a particular use case maybe included on a quality dashboard, along with alerts and notificationsto indicate to end-users when desired outcomes are varying from definedclinical standards. Thus, organizations can create dashboards based ontheir own idea of “best practice” care for a given disease state.

In certain examples, since combined content and best practices have beenstandardized, content from one organization using the clinical knowledgeplatform may be easily shared with other organizations utilizing theplatform. In addition, because the content within platform-relatedapplications is standardized in the same manner, upgrades to the exampleplatform can occur efficiently across organizations. That represents adramatic change from prior IT solutions which require unique IT upgradesbecause they are usually uniquely customized to each organization inwhich they are installed.

Generally, content is information and experience that may provide valuefor an audience. Any medium, such as the Internet, television, and audioCDs, may deliver content as value-adding components. Content representsthe deliverable, such as a DVD movie, as opposed to the deliverymechanism, a DVD player. As long as content conforms to the mediastandard, any compatible device can play it.

Content, as used herein, is the externalization or parameterization of“the instructions” that tell applications how to work. For example,content is a collection of externalized information that tells software,in conjunction with data, how to behave. In certain examples, a clinicalknowledge platform takes in and executes content against data to renderapplications visually and behaviorally.

Content includes data read and interpreted by a program to define ormodify presentation, behavior, and/or semantics of the program and/or ofapplication data consumed by the program, for example. Content includesdocuments presented to a client by a program without modification, forexample. Content may be created, stored, deployed, and/or retrievedindependently of the creation and deployment of the program(s) consumingthe data, for example. Content may be versionable to capture desiredvariation in program behavior and/or semantics, for example.

Classes of content may include configuration content, preferencescontent, reference content, application content, etc. Content types maycombine behaviors of two or more classes, for example.

Software vendors take many different approaches to customization. At oneextreme, some vendors write different software for each customer orallow customers to write software. At the other extreme, a vendor hasthe same software for each customer, and all customization occursthrough creating or modifying content. In certain examples, the samesoftware may be used for each customer, and customization is handledthrough content.

In healthcare, new laboratory tests, medications, and even diseases areconstantly being discovered and introduced. Structuring this as content,where underlying software does not need to change, helps accommodate anduse updated information.

In certain examples, many different content types, such as formdefinitions, data models, database schema, etc., are accommodated. Incertain examples, each content type may be used differently and involvea distinct authoring tool. Thus, in certain examples, content may referto “a collection of the content instances for all content types,” alsocalled a content repository, knowledge repository, or knowledge assets.For example, a content instance is a specific member of a content type,such as a heart rate data model.

In certain examples, each content type is associated with a generic,extensible structure that content instances of the content type follows.An example clinical information system can specify content in anabstract way that does not presuppose a particular softwareimplementation, for example. That is, another system, such as GE'sCentricity Enterprise, may consume content from a knowledge repository,apply a different set of software, and achieve the same behaviors.Additionally, an abstract content definition can more easily transitionto a new system. If one can extract content from a legacy system, aknowledge repository may be able to import and reuse it. Such acapability helps reduce a large barrier to change for potentialcustomers.

Content can change with time. In an example, a current knowledgerepository can handle any “old” data entered into a system under theauspices of an older knowledge repository. Occasionally, a question mayarise where someone could ask, “What did Dr. Smith see at some pasttime?” Under these circumstances, a current definition of a particulardisplay may not correctly reflect the situation at the time. An exampleCIS, unlike other systems, can bring back the old form for visualizingthe data since all knowledge assets are versioned and retained.

Content may need to vary for different circumstances. For example, anMPV may differ between emergency department (ED) and labor and deliverysettings. Each MPV has rows and columns of data specific to its setting.Context refers to being aware of and reacting distinctively to alocation and other situational differences. For example, interpretationof a patient's low temperature can vary based on location. If it occursin the recovery room after cardiopulmonary bypass with deliberatepatient cooling, it means one thing. If the patient is in the ED afterbreaking through ice into a lake, it means something completelydifferent. Context may vary based on user location, patient location,user role, and/or various other factors. In certain examples, contentmay be applied based on context.

Globalization is a process of adapting software so that it has nolanguage references, before embedding capabilities to make it suitablefor particular languages, regions, or countries. Having globalized it, aCIS may then translate it to other languages and cultures, calledlocalization. Globalizing a software product involves creating contentseparate from the software. For example, embedded text (e.g., usermessages), sort orders, radix characters, units of measure, dataformats, currency, etc., may be removed and parameterized. References tolanguages, character sets, and fonts may also be removed, for example.In certain examples, while display representations may be local,terminology concepts are applied universally, making a rule,calculation, or other content based on one or more terminology conceptsuseable worldwide without modification.

For example, FIG. 3 illustrates an example interdependence of contenttypes. As shown in the example of FIG. 3, content is a set ofinterdependent building blocks. Content may be thought of as ahierarchy, with terminology 310 (e.g., names of lab tests) as a lowestlevel. Terminology 310 may be common and coded across a customer base.Clinical element models (CEMs) 320 govern structure and content ofobjects stored in a database and used by applications. A formlet 330provides a way to display a particular content item (e.g., a way todisplay a particular lab result). A form definition 340 provides anapplication or view (e.g., a dashboard) of a collection of formlets(e.g., a multi-patient view (MPV) showing one or more lab results and/orother information). For example, if a particular MPV definition is movedfrom one customer to another, the MPV definition along with othercontent items on which the form definition depends are imported into thenew customer's knowledge repository. Content items may includeappropriate formlets, CEMs, and terminology, for example.

In certain examples, a detailed clinical model defines, at a granularlevel, the structure and content of a data element. For example, thedetailed Clinical Model for “Heart Rate Measurement” dictates the datatype of a heart rate measurement, and the valid physiologic range of aheart rate. It says that a “body location” is valid qualifyinginformation about a heart rate measurement, but a “color” is not. Itfurther decrees that the valid values for “body location” areterminology codes found in the “heart rate body location” value set.Moreover, it prescribes that a “resting heart rate” is an instance of“Heart Rate Measurement” where the value of “temporal context” is“resting”, where “resting” is also a coded value. A detailed clinicalmodel pulls the information together into a single, explicit, andcomputable form. The detailed clinical models or clinical element models(CEMs) govern the content and structure of all data objects stored in anexample clinical database and used by applications, for example. Inaddition, CEMs are extensible, such that content authors may add newCEMs or attributes to existing CEMs without requiring major changes todatabase structures or software, for example.

In certain examples, shared or portable content is, in effect, “plug 'nplay”. System administrators can add it (e.g., plug it into) to a systemwithout any software changes, and the content behaves in the intendedway and does not cause errors. The size or scope of shared content canrange from a single term to an entire knowledge repository, for example.Shared content fundamentally changes an implementation paradigm andreduces a total system cost of ownership, for example.

Customers can change shared content. Customers can improve it or make itmore suitable for their institutions. When customers do this, they leavethe original definition intact, but clone it and keep their changedversion in their “local” space, for example.

As described above, classes of content may include configurationcontent, preferences content, reference content, application content,etc. Configuration content is content that is modified infrequently andis concerned primarily with system behavior, for example. Examples ofconfiguration content may include internet protocol (IP) address andport of clinical knowledge database, identifiers of terminals insystems, security access privileges, configuration files, etc.Configuration content may affect program semantics, for example.Configuration content is generally modified by system administrators andis often stored in the file system, for example.

Preference content is modified frequently and is concerned primarilywith variation between users. Examples of preference content includedisplay colors and fonts, default search parameters, screen layout, etc.Preference content rarely affects program semantics and is most commonlymodified by individual users. While modified by users, the systemgenerally distributes initial or default preference content.

In certain examples, distributed or default preference content behavesvery similar to application content before modification by a user.Preference content may be context sensitive, transformed at deployment,etc. Preference content may include vocabulary concepts and pick-liststhat are resolved when loading and retrieving just like other contenttypes.

Reference content is documents that are presented without modificationas part of the application. Reference content is often stored in formatsthat are opaque to a program (e.g., as a PDF, a Microsoft Word™document, etc.). Reference content is generally not specific to orcustomized for a specific patient (e.g., instruction sheets, informationsheets, policies and procedures, etc.). Reference content may beindependent of program semantics and behavior. Reference content may beauthored independently of a program. While not an element of a contentdrive system per se, reference content is often managed as content by aclinical knowledge system. Once reference content is modified forpresentation to a specific user, the content starts behaving much morelike patient data/documents. Reference content with the structure toenable modification starts behaving much more like application content.

Application content may be modified frequently or infrequently dependingon use. Application content may be concerned primarily with applicationbehavior and semantics. Applicant content may be generally specific toan application domain. Examples may include a flow sheet template,clinical element models, terminology, document templates that aremodified and stored as patient data (e.g., hot text), etc. Terminologyis application content but has behaviors distinct from other applicationcontent types and is managed (largely) independently of otherapplication content, for example. Application data often affects programsemantics and behavior. Application content may be authored at multiplelevels in an organization or external to the organization, for example.

Application content may be implemented as a custom markup language, forexample. Application content may be implemented as a domain specificlanguage (DSL), for example. For example, data queries may beimplemented using a frame definition language (FDL). Clinical elementmodels may be implemented using a constraint definition language (CDL).Application content may be directly authored or imported as data into acontent store (e.g., concepts in a vocabulary server), for example.

In certain examples, while patient data is transactional and oftenincludes discrete data elements, application content is oftenstructured, complex objects and often has associated metadata. Incertain examples, metadata is data used to manage content, such ascontent identifier, version, name of author, access privilege,encryption certificate, etc. Metadata is not treated as content, forexample. While patient data is owned by a patient and is part of a legalrecord, application content is not owned by a patient and is not part ofa legal record. Application content may be published (e.g., is nottransactional) and managed using a lifecycle.

Certain examples provide content-driven systems and processes that relyprimarily on content to determine application behavior. An examplesystem includes a reference platform that consumes, interprets, and/orexecutes content while remaining application neutral. An example systemuses content that remains independent of an implementation of thereference platform to allow independent evolution of the platform andthe application.

FIG. 4 illustrates an example hierarchy 400 of content, associated datamodels, and terminology. In certain examples, once one chooses contentbased data models, content-based queries and data management are alsoselected. Content based applications are also chosen. An integralterminology basis includes semantics of data defined in terminologycontent, for example. As shown in the example of FIG. 4, applicationdefinition content 410 (e.g., MPV templates, form(let) definitions,interface mappings, and/or document templates, etc.) relies on datamanagement content (e.g., frames) 420 (e.g., data query definitions,data update definitions, and/or data transformations, etc.). The datamanagement content 420 leverages data models (e.g., CEMs) 430, such asclinical data organization (e.g., structure) and/or coded clinical data,etc. The data models 430 are constructed based on a terminology 440including clinical concepts and relationships between concepts, forexample.

In certain examples, context refers to metadata attributes and/or labelsthat differentiate variations of a content item. For example, eachvariant of content item may be referred to as a context variant. Eachvariation of a content item has a specific set of context attributes(e.g., language, location, role, etc.). An algorithm or heuristic mayselect a desired variant when retrieving based on a current user's“context.” This process may be referred to as context resolution.

Searching refers to examining the content item and/or associatedmetadata for matches independent of context. Searching can includecontext attributes to filter for specific context variants in thesearch. The difference is that a specific variant is not selectedalgorithmically or heuristically by the content system when searching.Using the “user” as a context attribute is one way to associate acontent item with a specific user; similarly provider as a contextvariable could be used to associate an item with a group of users.Resolving context generally requires some heuristic to resolve ambiguityor conflicts among context variants (e.g., weighting or priorityschemes, default rules, etc.). This leads to some ambiguity sincechanging/adding a context variant or changing the weights of contextattribute may change the context resolution on another item in notalways obvious ways (at least to a user).

In certain examples, a content item includes:

1. A root content item represented by a universally unique identifier(UUID). The root content item includes metadata only; no actual contentis stored.

2. One or more context variants that represent variations of animplementation of the content item in different client contexts occur aschildren of the root content item.

3. Context variants may form trees of increasing context specialization(e.g., a context variant may have child variants).

4. Each context variant has a unique UUID as well as a relation to theroot content item.

5. Each context variant maintains versions of that variant as changesare applied to the variant.

As shown in the example of FIG. 5, a root content item 510 has one ormore content variants 520-522. Each content variant 520-522 may beassociated with one or more context variants 530-531.

FIG. 6 provides an example multi-patient view (MPV) 600 made up of aplurality of formlets 610-614 and a frameset 640. Each formlet 610-614corresponds to a concept 620-624 and a model 630-634. The frameset 640is also associated with each model 630-634, and each model 630-634 isassociated with a concept 650-654, for example.

In certain examples, content may be stored in multiple content stores.For example, content may be stored in an ECIS database, an XDSrepository, a third-party system, etc. Content documents in storage maybe identified by a URI that specifies the content store and the key ofthat item in that content store. A content directory including thecontent metadata may be searched to obtain the URI for retrieval of thecontent item. A content type manager may specialize the search, storage,and/or retrieval of items of that content type, for example.

A content item in the content directory is keyed via a UUID for theitem. That UUID is not necessarily part of the uniform resourceindicator (URI) that defines the storage location.

In certain examples, content items may be organized as a content type. Acontent type is a set of content items that are defined and managedusing common definitions and methodologies (e.g., terminology, clinicalelement models, frameset definitions, etc.). Content types may havedifferent behaviors, states, lifecycles, etc. Each content type may bemanaged by a specific content type manager, which is treated as aplug-in to a clinical knowledge platform and/or associated clinicalinformation system, for example. Content types may be added by creatinga new content type manager, for example.

Content type managers may interact with a content management frameworkby implementing a set of event handlers (e.g., package, deploy,retrieve, etc.). “Generic” content types (e.g., content types with nospecial behavior) may use a default content type manager. An owner of acontent type is responsible for implementing an associated content typemanager, for example.

In certain examples, during authoring (that is, before deployment),dependencies exist between content items. At runtime (that is, afterdeployment), dependencies exist between deployed forms of contextvariants. Dependents that exist during authoring may or may not continueafter deployment. For example, terminology description and pick-listresolution are translations during loading and retrieving, notdependencies per se.

In certain examples, at runtime, dependencies are between deployed formsof context variants, not the context variants themselves. The deployedform of a context variant is a “content frame”. At deployment time, itmay be necessary to guarantee that the packages (e.g., terminology) thata package depends on are also deployed. Terminology dependencies may beinferred from terminology relationships and mappings and do not need tobe explicitly tracked.

In certain examples, a content based system provides a capability todistribute content and content updates to external instances (e.g., testsystems, quality assurance systems, customer installations, contentpatches (SPRS), etc.). An example distribution system provides acapability to distribute content items and associated dependent contentitems and/or insure that those content items already exist in the targetsystem. For example, an FDL content item must have access to theclinical element types it references in order to process a frame query.The example distribution system may also facilitate an undo or reversalof installed content items that generate issues. Content may bedistributed as large sets of items (e.g., during installation) and/or asindividual items (e.g., bug fixes), for example.

FIG. 7 illustrates an example content management process 700. Theexample process 700 includes authoring 710, packaging 720, exporting730, importing 740, deploying 750, loading 760, and retrieving 770.

Authoring 710 includes a process of creating and/or modifying a contentitem. Authoring may be done by an author composing content directlyusing an editor (e.g., CDL, FLD, etc.), for example. Authoring may bedone using tools (e.g., editor(s), etc.) that are specific to acontent-type (e.g., terminology), for example. Authoring may be done bytools within the application(s) consuming a content type (e.g., MPV,forms, etc.), for example. Authoring may be done by applicationsgenerating a content item (e.g., MPV generating FDL), for example. Incertain examples, there is no single authoring environment for content;rather, there is a family of authoring tools that is often content typespecific.

Packaging 720 includes combining all content items and (applicable)context variants within a transitive closure of dependency graphs of oneor more content items into a package, for example. Packages may includemultiple independent top level content items, for example. Packages mayhave dependency(-ies) on other package(s). For example, a packagecontaining a frameset content item may dependent on a separateterminology package as a prerequisite to deployment.

Packages may very frequently contain multiple independent, top levelitems each with its associated dependency graph. A package may notinclude all context variants of an item. For example, packaging mayfilter based on context to form a package. Packaging events may includean event to allow a content type manager to specify dependencies of anitem being packaged.

Packages may have dependencies on content types other than contentpackages. For example, a terminology package is a different content typethan a content package. Content items within a package may not haveexplicit dependencies on terminology concepts. Rather, the package hasdependencies on the appropriate terminology packages.

In certain examples, packages are used as a distribution mechanism.Packages may be deployed before items in the package are available to aruntime system, for example. Packages themselves may be treated ascontent items. Thus, packages can themselves be packaged (e.g., packagesof packages), and packages may be dependent on other packages. Incertain examples, packages may belong a namespace or domain. Forexample, packages may only include items from a single namespace.Packages may have dependencies on packages in another namespace, forexample.

Package(s) may be exported 730 from one system and imported 740 intoanother. Exported packages may be used to distribute content, forexample. System management tool(s) may be provided to create, export,import, and deploy content packages, for example.

Deploying 750 includes making content items included within a packageavailable to a running system. A content item may be transforming duringdeployment, for example. For example, constraint definition language(CDL) models may be compiled and may create multiple type objects eachwith an associated schema. As shown in the deployment example of FIG. 8,a plurality of models 810 in a content package 815 are deployed 820 tocreate a content frame 830 including plurality of type objects 835 withassociated XML schema.

In certain examples, each top level content item in a package beingdeployed is deployed independently. A deployed content item is logically(and often physically) a different object than the content item beingdeployed. For example, a deployed content item has independent state andlifecycle. Multiple content items may be created during deployment, forexample. For example, deploying a CDL model may generate a CE typeobject and an XML schema. In certain examples, a source content item maynot exist in the runtime system. For example, the source CDL models arenot employed, and the generated CE type object is deployed. Deploymentof a package may be done manually and/or implicitly by an authoringtool, for example. For example, system administrators may wish toexplicitly control deployment of data models but MPVs authored by a usermay be implicitly and immediately deployed.

In certain examples, each deployed content item is bundled with all ofthe content items that are used to execute and/or consume the item. Thebundle is referred to as a content frame 830. A content frame 830 isanalogous to an archive file manifest. It may not (necessarily) containthe actual content items. The content frame 830 may not include all ofthe items generated during deployment. For example, the CDL schemas maynot be part of the frame.

A content frame 830 is also analogous to a context variant. The framehas its own unique identifier but may be retrieved using the identifierof the root content item the frame is based upon in the same way thatcontext variants are retrieved. Deployment events may include an eventto allow the content type manager to specify dependencies of thedeployed item(s) within the content frame, for example.

In certain examples, context resolution refers to conditioningselection, composition, and/or behavior of a content item based on acontext of a user. Context resolution may occur at one or more levels.For example, context resolution may occur on selection of the contentitem(s) that a content item being deployed is dependent upon based oncontext. Such resolution occurs during deployment, and content framesare context specific with dependencies resolved. Context resolution mayoccur on selection of a content frame based on context when the contentframe is retrieved by an application, for example. Context resolutionmay occur on translation of a content item based on context when loadingand/or retrieving a content frame, for example. For example, contextresolution may occur upon retrieval of terminology concept designationsand/or retrieval and population of pick-lists.

Translation may be performed by the content type manager during loadingand/or retrieval, for example. A template tool such as Apache Velocitymay be used to implement the translation. The sensitivity of a contentitem to changes in the terminology server is a function of when thetranslation is applied e.g., during deployment, loading, or retrieval),for example. During deployment, context may be usedalgorithmically/heuristically to select dependent items and/or thedeployment tool may specify the required dependent items. In general,context resolution is done heuristically (e.g., scoring and weightingschemes) because of the difficulty in determining an unambiguousalgorithm to resolve conflicts. The content type manager may provide itsown mechanism for context resolution, for example.

In deployment 750, a content item may be a part of multiple contentframes. For example, multiple copies of a content item may be loaded byan application if it loads multiple content frames containing the item.Applications may search for and retrieve content frames. For example,content management may load and cache content frames. In certainexamples, authoring tools may retrieve content items directly. Runningapplications may retrieve content frames during execution, for example.

Context may be resolved while constructing a content frame. That is,selection of context variants on which the deployed content item isdependent is done during deployment, for example. Content frames maythus be context specific. During load and retrieve, context may be usedto select a content frame, not content items contained in the frame, forexample.

A content frame may itself be considered a content item. Thus, thecontent frame may be versioned, have associated metadata, etc. Since acontent frame is a content item, packages of frames may be constructedand distributed content frames without the associated source contentitems, for example. In certain examples, content frames may containcontent frames, allowing courser grained deploy and undeploy operations.In certain examples, optimizations to frame loading (e.g., loading asingle copy of a common content item) may be done, if desired, usingtechniques such as reference counting, etc.

In certain examples, content frames are related to a deployed rootcontent item in a fashion analogous to the relationship between contextvariants and the content item. For example, a content frame isidentified by the same UUID as the root content item in the frame andshares the same directory metadata. Each content frame may have its ownunique identifier that may be used as a reference. Each content framemay be context specific and may have multiple versions. In certainexamples, only deployed content items have associated content frames.Because of this relationship, content frames may be treated in adirectory as properties of a content item along with context variants,for example.

In certain examples, content may be undeployed. An undeploy is a processof a making a (deployed) content frame unavailable to a runninginstance, for example. However, data instances stored in a CDR may bedependent on the content frames used to create the data instances (e.g.,clinical element (CE) types). As a result, a content frame, oncedeployed, may not be physically deleted from the clinical content systemwithout compromising referential integrity, for example. Undeploy, then,may make a content frame invisible to subsequent searches and contextselection. Through undeploy, a previous version of a content frame maythen be once again visible to search and context selection, for example.In certain examples, an undeployed content item may still be directlyretrieved using the UUID for the content frame.

In certain examples, content item translation refers to modifying acontent item during loading and/or retrieval to make the content itemresponsive to changes in content items on which it is dependent withoutredeploying the content item. For example, terminology designations andpick-lists may change independently of the deployment of the contentitem. Content item translation may be a responsibility of a content typemanager responsible for a content item. For example, translations thatmake sense for one content type may not make sense for another contenttype. Content item translation may be context specific, for example.Content item translations may be performed by inserting custom macros ina content item (e.g., at authoring time) and applying a template tool toexecute the macro and perform the translation with the item isretrieved.

Content item translations may be fine-grained. For example, they do notchange the structure of the content item but replace elements (e.g.,labels, lists of labels, etc.) within the item. Course grainedmodification of content frames (such as re-resolving content items thatthe content item being retrieved is dependent upon at retrieval time)may be undesirable because they can lead to unpredictable changes toapplication appearance or behavior. Hence, these kinds of modificationare restricted to occurring at deployment time. In certain examples,common tools may be used to perform translation of content itemsrepresented in XML or HTML. Apache's Velocity is used here as an exampleonly. Dependencies for items that depend on translations may be managedby maintaining a content frame dependency on a content frame containingthe items to be translated (e.g., a terminology content frame) ratherthan by maintaining specific dependencies, for example.

Loading 760 is a process of retrieving a content frame containingdeployed content item(s) from storage and making the frame available foruse by running application(s). Content items in a content frame may betranslated during loading. For example, terminology designations may beresolved and/or pick-lists retrieved. A content frame may be cachedafter loading. Content items contained within a content frame may beloaded as a single operation, for example.

In certain examples, the choice of doing translation at retrieval timeor load time is up to the content type manager. Translating at load timemeans that the cost of translation is amortized over multiple uses ofthe item; translating at retrieve time means that the item is moresensitive to context variation and changes in resolved content. Aselection of translation time may be content type specific, for example.

Retrieving 770 includes fetching a loaded content frame by a consumingapplication. Content items within the content package may be translatedduring retrieval (e.g., resolving terminology designations, retrievingpick-lists, etc.). A loaded content package may be retrieved multipletimes by different clients, for example. An application may choose toreuse (e.g., cache) a retrieved content package at its discretion.Content items within a content frame may be loaded as a singleoperation, for example. In certain examples, since a content item may bepresent in different content packages, different instances of an itemmay be translated using different context. For example, an applicationmay show a content item in two different languages concurrently forcomparison.

A choice of doing translation at retrieval time or load time may be madeby the content type manager. Translating at load time means that thecost of translation is amortized over multiple uses of the item.Translating at retrieve time means that the item is more sensitive tocontext variation and changes in resolved content. A selection oftranslation time may be content type specific, for example.

In certain examples, content may be divided based on namespace. Anamespace is a partition of content items in a system where eachpartition is owned and managed independently of other partitions. FIG. 9provides an example of namespaces A, B, and C including various contentitems (CIs).

Namespaces may be motivated by various factors. For example, contentitems in one namespace may be protected from modification by anotherparty (for example, a customer modifying GE distributed and ownedcontent). Applying maintenance (e.g., updates, bug fixes, etc.) becomesdifficult, if not impossible, if a customer can modify GE distributedcontent (e.g., customer modified content may potentially be broken whenreplaced with an update). Alternatively or additionally, for example,customers may be allowed to add and extend distributed content in safeways while enforcing governance restrictions on such modification (e.g.,models may not be modified or extended, but MPVs may).

While some of these restrictions may be enforced by a security system,customers often set security policy, so another mechanism may be used toenforce such restrictions. Additionally, some rules such as inheritancerestrictions may not be adequately managed via security policy.

In certain examples, a simplified namespace model provides that eachcontent item in a system may be searched for using a single namespaceprecedence order. It is possible that different content types mayinvolve different search precedence (e.g., a search path to resolve datamodels may not be the same as a search path to resolve forms orreference content). Extensions to the model can be made based oncircumstances, for example.

In certain examples, namespaces may be “owned” by a provider, a customerinstitution, a department, etc. Such ownership separates providercontent from customer content, for example. Multi-tenancy and digitalrights management may be facilitated through the use of namespaces, forexample. In certain examples, only the owner of a namespace may createor modify content items within the namespace. An owner may own multiplenamespaces, for example. A clinical knowledge platform and/or associatedenterprise clinical information system may serve as an owner of a “root”namespace (and possible others), for example. Each customer installationmay be an owner of at least one namespace for that customer, forexample.

In certain examples, an “owner property” on a content item used as acontext attribute is also presented in some contexts as equivalent to anamespace. However, in context resolution, using an owner property theremay be no inherent precedence. For example, given a concept withdesignations potentially owned by A, B, and C, an application asks forthe designation owned by A but that designation does not exist. Does thesystem return designation B or designation C? In general, propertyprecedence in context resolution involves a heuristic to resolve (e.g.,weighting and scoring schemes).

Additionally, there may be necessary relationships between content itemsin namespaces. For example, specialization via inheritance, overridingcontent items in one namespace with the same item in another, copying anitem from one namespace to another (e.g., is it legal to do the copy?),etc. These behaviors may or may not be able to be implemented using anowner property (alone) in the general case.

Additionally, “owner” may be used in at least two different senses:first, as an intellectual property/digital rights management (IP/DRM)concept where it designates actual ownership (e.g., a package by “owner”is a practical application of this concept—package everything that isowned by an owner); second, as an attribute used to select adesired/appropriate context variant when retrieving a content item. Thissecond usage is more directly analogous to namespaces with the caveatsabove.

In certain examples, a difference between an owner context attribute anda namespace is that namespaces are known to and defined by a systemrather than defined independently for each content item in content(e.g., owners are generally terminology content). The system canestablish precedence, maintain persistent/immutable relationshipsbetween items in different namespaces without expectation that therelationships will change, for example. That is, “namespaces” may bepart of a reference implementation; owners are content defined and hencemay be interpreted by the reference implementation, for example.

In certain examples, namespaces have “precedence” when searchingretrieving, etc. For example, as shown in FIG. 9, a highest precedencenamespace C is first searched for a content item, then a second highest(e.g., namespace B), etc. Precedence may be established when configuringthe system or defining the name spaces, for example. Precedence may beoverridden when deploying a package.

In certain examples, relationships may exist between content items inone namespace and content items in a lower precedence namespace. Incertain examples, changing namespace precedence may change the nature ofa relationship.

In certain examples, a new content item may be created in a higherprecedence namespace by copying an item in a lower precedence namespace.For example, an MPV may be copied from base content, modified, and savedas a user-owned MPV. A content item may be created in a higherprecedence namespace that hides or replaces the same content item in alower precedence namespace, for example. For example, a new version of aformlet that hides the same formlet in base GE Qualibria® content tocustomize display of that formlet. Creating a new content item thatspecializes (e.g., inherits from) an existing content item may hide orreplace a base content item in a lower precedence namespace. Forexample, a new attribute may be added to a patient clinical elementmodel provided by Qualibria by specializing the Qualibria patient model.

In certain examples, namespace relationships are managed by a contentmanagement system. If a base content item is modified, a specializedcontent item may need to be redeployed. In certain examples,specialization of a content item in a namespace may be allowed inanother namespace but copying the content item may not be allowed. Statechanges in a base content item may involve state changes in aspecialized content item (e.g., if the base item is deprecated, thespecialized item may also require deprecation), for example. In certainexamples, digital rights management may prevent a copy of a content itemfrom being created. In certain examples, if a content item that wascopied to a new namespace is modified, an owner of the target namespacemay need to be notified of the change so the copy can be reviewed forchanges.

In certain examples, an owner attribute on a content item may beinsufficient to manage namespace relationships. Clinical element models(CEMs) are an example of a relationship restriction: copying and hidinga CEM can lead to data inconsistencies while specialization throughrestriction or extension can be safely done. Hiding an MPV on the otherhand, is generally a safe operation, for example. In certain examples,relationship management/enforcement is a responsibility of a contenttype manager (CTM), or at least the CTM should be able to specializesystem relationship management.

Namespaces may be used in a variety of stages of a process. For example,namespaces may be used during authoring. For example, namespaces may beused when resolving context variants, establishing relationships such ascopy, copy and hide, etc. Namespaces may be used during packaging, forexample. A package may include content items from a single namespace,for example. Context variants, relationships, etc., in other namespacesinvolve dependencies on packages in those namespaces, for example.Namespaces may be used during deployment (e.g., when resolving contextvariants, when establishing relationships such as inheritancerelationships, etc.), for example. In certain examples, namespaces arenot used during load and retrieve at runtime.

In certain examples, each context variant of a content item has acurrent “state”. For example, a state may include deployable, deployed,loaded, deprecated, etc. Each content type has a set of allowable statesand a set of allowable state transitions represented as a state machine.Content types may have different state machines in an authoringenvironment than in a runtime environment, for example. State machinesmay be owned by a content type manager since the manager defines ameaning of each state for a content type.

In certain examples, a state in a runtime system is actually the stateof the content frame. However, for simplicity, a state of the contentframe is assumed to be (and managed as) the state of the root contentitem. A state of content items included via dependency resolution may beirrelevant to the runtime system (e.g., it may be required that the rootcontent item of the content frame be redeployed to bubble up statechanges in that item).

In certain examples, lifecycle management refers to a set of workflowsthat manage transition of a content item from one state to another. Eachstate in a content type state machine is associated with a distinctworkflow that manages the content item when in that state, for example.In certain examples, workflows are content items to allow variationacross implementations.

FIG. 10 depicts an example of a state versus a workflow. As shown in theexample of FIG. 10, each state in a content item state machine 1010 hasan associated workflow 1020 that controls transition(s) to the nextstate(s).

In certain examples, governance refers to a set of policies that managelifecycles of each content type. Governance policies are implemented instate machines and associated workflows of a content type, for example.Governance may be an operational function, for example.

Certain examples provide a content-based clinical information systemincluding a stable reference platform that defines and executes the corecapabilities of the system and a set (e.g., one to many) of contentclasses (e.g., content based languages) that are implemented upon thereference platform and that independently define clinical informationfunctions. The content classes are specialized to allow implementationof narrowly defined clinical functions, for example, Defined clinicalfunctions can include data definition, data query, data transformation,data display, data entry, decision support rules, etc., for example.

In certain examples, clinical applications are created by composing oneor more content items (e.g., instances of a content class) from one ormore content classes. Each content item is authored or createdindependent from the creation of the reference platform. Content itemsand the reference platform can have independent life-cycles and evolveindependently over time, for example. Since content classes areindependent, support for additional content classes can be added as anupdate to the reference platform to extend core system capabilities, forexample.

Certain examples provide content and data, along with executablesoftware or code. In certain example, content includes data andexpressions/instructions concerning data. However, neither data norcontent is “software” as the term software is traditionally defined. Incertain examples, content is stored in a content database and isindependent of hard-coded libraries. Thus, clinicians do not need a newinstallation of software to change an application, such as amulti-patient view (MPV) dashboard. Other dashboard views can include arapid recovery dashboard, a hospital-acquired infections dashboard, etc.Content can be configured by a clinician, technician, and/or other userat a location without the platform provider's intervention. Clinicianscan author new MPVs on the fly, for example. In certain examples,content can be used to facilitate a query for data by a user and/orapplication.

FIG. 11 illustrates an example clinical information system 1100including a reference platform 1110 and one or more content items 1120that define clinical functionality (e.g., content-based applications).The example content-based clinical information system 100 of FIG. 11includes a reference platform 1110 having three major layers 1112, 1114,1116.

In the example system 1100 of FIG. 11, Reference Platform Services 1112provide foundation services to implement content class managers andinterpreters. The reference platform services 1112 are constructed usingstandard software development techniques and can be modified independentof content items implementing application functionality to enhanceavailable system functionality without impacting the applicationfunctionality, for example.

In the example system 1100 of FIG. 11, a Content Class Managers layer1114 implements management services for one or more content classes. Acontent class includes defined (e.g., a narrowly defined) domainspecific language that allows clinical personnel to define customprogrammatic elements (e.g., content items) that will be used whencomposing a clinical application (for example, clinical vocabularyconcepts, clinical data models, data queries, data transformations,display forms, etc.). An example Content Class Manager providescapability(-ies) to author content items of that content class. Theexample content class manager provides capability(-ies) to package thosecontent items for distribution, export and import the content items fromand to installations of the clinical information system, and deploy thecontent items to a running clinical information system (e.g., compile,translate, etc., the content item into an executable form). The examplecontent class manager provides capability (-ies) to load the contentitems into memory while performing context-based translation of thecontent item (e.g., resolve terminology designations, pick-lists, etc.),and to retrieve the content items for execution in an associated contentclass interpreter. While a running clinical application can includecontent items of different content classes, each content item isindependently managed by the content class manager associated with thecontent item.

In the example system 1100 of FIG. 11, a Content Class Interpreter layer1116 defines one or more interpreters (e.g., programs that consume acontent item and execute the instructions defined in the content item)for content items of each content class. Since an application is acomposition of content items, multiple content class interpreters canparticipate in the execution of the composed application(s). Contentclass interpreters consume a deployed (e.g., executable) form of thecontent item(s). Optimizations and/or other improvements to performanceof a content item interpreter can be implemented in conjunction with acontent class manager, for example.

Content Based Applications are composed of one or more content itemsthat are managed by content class managers and executed by content classinterpreters. A set of content items of which an application is composedare stored in a content repository and managed as a set ofinterdependent items. Content based applications are independent of thereference platform; that is content based applications can be changedwithout changes to the reference platform, and the reference platformmay be changed without changes to the content based applications (thoughcontent based applications may be changed to take advantage of newcapabilities in the reference platform), for example.

Since medical practices vary widely between different institutions (andeven within institutions or between patients) and change rapidly asmedical practices evolve, prior clinical information systems requireextensive customization to be deployed widely. Very frequently, thisdegree of customization can render ongoing maintenance (e.g., newreleases, error fixes, etc.) difficult or even impossible. Additionally,responsiveness to requests for customizations may be unacceptable to theinstitutions because of the difficulty in creating, testing,distributing, and managing the customizations.

Two common approaches to these issues may be found in existing products.First, the producer of the system tightly controls the software systemand controls/restricts the changes that can be made to the system,thereby severely restricting the ability of the software to becustomized to specific customer needs. Second, the producer of thesystem may allow extensive customization of the software wherein eachimplementation becomes essentially a custom system which limits themaintainability of the system.

Certain examples address these problems by separating the application,where customization generally occurs, from the system itself, wheremaintenance generally occurs. An example clinical information systemapplication is implemented in content, that is, as a set of contentitems that are created and maintained independently of the system, oftenby the customers of the system themselves. The reference platform (e.g.,the system) is maintained, enhanced, tested, and deployed by a vendor.Since the application (in content) is independent of the referenceplatform, the two can evolve largely independent of each other.Independent evolution allows a much greater degree of possiblecustomization without reducing the maintainability of the system, forexample.

Rather than basing content on a single general-purpose interpretedlanguage, certain examples implement a content based system as a set ofcontent languages. In certain examples, each content language isnarrowly focused and specialized to allow independent evolution,optimization, etc.

In certain examples, by separating applications from a referenceimplementation, independent evolution of the application and the systemcan be supported. In certain examples, application(s) can be authored bydomain specialists rather than by engineering. For example, terminologyand data can be modeled by informaticists; clinical forms can bedesigned by clinical teams; etc. In certain examples, functionality canbe added to the system incrementally by adding new content classes tothe system. Since content classes are narrowly focused for specifictasks, a risk of over-generalization is reduced or avoided, for example.Content classes can be independently evolved and improved/optimized, forexample.

In certain examples, clinical content includes structured knowledgecomponents such as decision support rules, protocols, reports, userpreferences (e.g., triage form layout, patient and/or departmentworklist format, etc.), and unstructured knowledge components such asdischarge instructions, guidelines, etc. Clinical information systems(CIS) that are content-driven provide functionality that improvesclinical outcomes by enhancing compliance withinstitutionally/nationally recognized standards of care and reducepractice variation. In certain examples, a new process has been definedto streamline clinical content management from its inception to itsconsumption by the CIS.

The example process allows for building of an infrastructure formanaging clinical content in a more efficient and more optimal manner.Using this clinical content management process, clinical contentmanagement is scalable and expressive, for example. When a CIS isintroduced into a new environment, lack of a standard process interfereswith resource planning, effort planning and estimating timelines, forexample. An example clinical content management infrastructure builtaround this process can help with the implementation effort byidentifying appropriate dependencies, breakdown tasks along with theirassociated resources, and help align priorities.

In an example, a small client is interested in going live with a coupleof clinical modules (e.g., a discharge module and a billing module). Aspart of these modules, using the example content-driven process,structured and unstructured clinical content can be authored, versioned,packaged, and tracked to ensure compatibility with future updates.Building on the example use case, if the client wants to add its ownlocal content, plug-n-play packagers and deployers are provided that areapplicable only to these two modules. If the client is happy with thetwo example modules and wants to go live with additional modules, theinfrastructure built around the process can scale up to identifypotential clinical content interdependencies, help eliminateredundancies, and bridge clinical application versions and clinicalcontent versions, for example.

In certain examples, the clinical content management infrastructure canbe integrated into a software lifecycle to eliminate separate iterationsand planning exercises. Integration can produce significant savings inplanning, effort, and execution time, for example.

In certain examples, during the content authoring and packagingprocesses, the infrastructure verifies and validates dependencies andhelps ensure content integrity, for example. The infrastructure easesthe process of versioning at the content and package level.

In certain examples, future updates can be automatically packaged aspatches that can be released internally and/or externally to clients ona pre-determined schedule. Patch releases can still maintain contentintegrity that can be described through a conformance statement, forexample.

Thus, certain examples provide a clinical content management processthat is scalable, expressive, and semantically interoperable. Forexample, the process is scalable in that it can support core content asdetermined by an application's needs in addition to customer/competitorspecific content. For example, the process allows end users to consumecontent to support individual preferences at an enterprise level. Forexample, the process provides an infrastructure for clinical entities tocreate semantically interoperable systems to derive clinical, researchand business benefits thereof.

From a business standpoint, the example process enables modular contentpackages and pluggable deployment. This flexibility allows tailorablecontent to support different types of clients to augment a “surround andsupplement” strategy, where-in a small client with limited budget can golive with only couple of modules/content-deployers, whereas a largeenterprise customer might want a whole suite of content managementinfrastructure.

Certain examples define processes apriori to help ensure that structuredand unstructured clinical content development and management is morepredictable, measurable, efficient, and integrated into applicationlifecycle management. Current systems and/or processes for managingclinical content in content-driven systems are fraught withuncertainties such as in version compatibility, quality control, timelypackaging and delivery of content, updating knowledge bases, and smartdeployment.

Building a clinical application on an infrastructure as described hereinprovides significant benefits to a content management process such asmaking it scalable, expressive, supportive of standard(s), semanticallyinteroperable, and flexible.

In certain examples, content and infrastructure can be used to map orresolve concept identifiers into human-readable designations using aterminology.

One example of how a clinical information system might be configured isa patient admission screen. The software for the clinical informationsystem includes an admission screen for new patients. The admissionscreen includes a form associated with a workflow directing whichinformation to collect and when to collect it. The admission screen mayalso display other information about the patient or hospital to assistthe care provider during the admission process. While the systemincludes an admission screen that works well for many hospitals, it willnot have everything needed for every situation.

Different hospital networks may want to change the admission process tobe different from the one that is included by default with the software.In those cases, they will want to modify the admission process to fitthe needs of their network. Within the hospital network, there may be aregion that needs to modify their admission process. Within that region,there may be a hospital that needs to add a step in the admissionprocess specific to that hospital. There may even be a care provider whowishes to modify the way the admission form is laid out to fit a userspecific need.

These modifications are based on a context. The region, hospital,language, and user all help to define the context for the particularadmission process. The context is based on a hierarchy where thehospital depends on what regions it is in, and the user depends on whathospital it is in. For example, a user might customize their layout ofthe admission form one way when they are working at one hospital. Itmight need to be customized another way at a different hospital.

Traditionally, preferences are stored in a separate data store or storedlocally on a client workstation. The system retrieves the content andpreferences separately, and then the system alters the content based onthe preference. This requires the consumer of the content to be aware ofthe preference system and also requires the consumer to alter thecontent.

An example of a traditional preference application is an admissionsscreen for collecting new patient information. The system may want toallow users to choose if the form was displayed vertically orhorizontally. The form itself could be saved as content in a contentrepository. The system could save the preference, vertical orhorizontal, in the preference storage. The application would need toretrieve the form, and then it would need to read the preference for theuser and modify the form to appear the way the preference indicated.This requires the application to be programmed in a way that it knowswhat all the possible preference are, and it would have to know how tomodify the form to fit those preferences at runtime.

In certain examples, a clinical information system providesfunctionality for users to define what the preferences are based on eachhierarchical context as needed or desired. The CIS should then provide acorrect admission process for the context that exists at admission time.Certain examples provide an intelligent, preference-based content systemcapable of storing hierarchical-based preferences.

Certain examples store content for each preference separately. Aconsumer passes in a context when requesting content, and the contentfor those preference(s) is returned. There is no need for the consumerto analyze the preferences or alter the content. In the patientadmission example, an admission form is stored as content to be used bydefault in the application. If a care provider prefers to change theadmission form, the user specifies the desired change, and the systemstores that form as content in the content system. The new content isstored with context information that includes the specific user. Whenthe system retrieves the admission form, the system identifies that thecontext includes the specific user, and the content for that user isused. The content storage is aware of the context, but the consumer didnot need to know what the preference was and did not need to alter thecontent.

Language provides another example of how a preference can be stored ascontent. A patient discharge form can be stored by default in English.In a bilingual hospital, care providers may speak two languages, but apatient may only speak one language or the other. A second dischargeform can be stored as content with a context indicating that it is in asecond language different from a first language (e.g., a discharge formin Spanish and a discharge form in English). The patient's language isincluded as part of the context when retrieving the discharge form fromthe intelligent, preference-based content system. The application thendisplays the correct discharge form.

In certain examples, by storing preferences as content, preferences donot need a separate data store. Preferences can be assigned that areuser and/or patient specific. Preferences are stored as content, so aconsumer of the content does not need to have a knowledge of thepreference system. Preferences can follow a user across workstationsand/or be centrally managed, for example.

In certain examples, the system and associated software is flexible andconfigurable by end users. The flexibility and configurability shouldimprove adoption by and usefulness for clinicians, for example.Context-based preference configuration and storage can be provided aspart of an enterprise clinical information system, such as GE'sQualibria® system, for example.

Certain examples resolve multiple variants of a content item based onwho, what, and/or where the content consumer is. This allows consumersto create, specialize, and/or customize their own content on top ofvendor-released content (e.g., shareable and interoperable content).This allows for a single content type to vary by properties associatedwith the content consumer without the need to customize everyapplication that consumes that content to be aware of the rulesnecessary to vary the display of the content.

In clinical applications, there are often times that information anddata are to be displayed in different ways based on a context ofapplication use. A role of a clinician may impact what clinicalinformation he or she wants and/or needs to see and how he/she wants orneeds to see it. A location of a user may also impact a type ofinformation that is desired to be displayed based on clinical need,preference, etc. Clinical information may also be displayed in one ormore languages, especially for patients.

Resolution of context by an application allows appropriate informationto be displayed based on who, what, and/or where the user of theapplication is. This ability enables streamlined workflows and targeteddocumentation for clinical use. This also gives flexibility to customizecontent for specific use(s).

In certain examples, a content management system implements workflowactions to perform location management for a location model. The systemmay implement workflow actions to perform a bulk import and export oflocations for a selected location ontology, for example. The system mayimplement workflow actions to perform a bulk update of locations for aselected location ontology, for example. The system may implementworkflow actions to perform a CRUD (Create, Read, Update and Delete)operation for a location relationship between locations, for example.The system may implement workflow actions to perform a CRUD operationfor a location relationship for a location and location ontology, forexample. The system may implement workflow actions perform a CRUDoperation for an association of a location to a patient, for example.

In certain examples, a model with a type of location defines a singleindependent instance of data (e.g., a data object with an identity)describing a specific location (e.g., a facility, department, room, bed,etc.), and including information used to establish an identity of thelocation. Additional, non-identifying information about the location(e.g., information such as certifications, etc.) may be stored asinstance(s) of a data statement reference class, for example. Specifyinga reference class of location indicates that the model is aspecialization (e.g., extension) of a location reference class.

A location reference class may include data constraints and componentreference-class constraints (e.g., component, qualifier, modifier, andattribution), for example. In certain examples, a location referenceclass may not include instance derived reference-class constraints(e.g., statements, associations, etc.). Data constraints appearing in alocation derived model result in the generation of an anonymous datacomponent to contain the actual data constraint, for example.

A model with a type of location relationship defines an association thatis not owned by a patient, where associated instances are assumed to belocations with a typed relationship between them. To define thisrelationship, a location relationship instance contains one or morereferences to independent instances of reference class location.Constraints for the reference class location instance references mayinclude a role constraint to specify the role each location instanceplays in the relationship, for example. Specifying a reference class oflocation relationship indicates that the model is a specialization(e.g., extension) of the location relationship reference class, forexample.

A status constraint is used in a model derived from the locationrelationship reference class. The status constraint may contain adefault processing instruction to allow the constraint to be transparentto a derived model.

Element constraints contained within a location relationship derivedreference class that specify a reference-class constraint derived fromthe instance reference class may optionally include the role constraint,for example. The role constraint may contain a default processinginstruction to allow the constraint to be transparent to a derivedmodel. If not specified, role may defaults to unspecified-role in theassociation-role domain, for example.

A location relationship type model may include data constraints andcomponent reference-class constraints (e.g., component, qualifier,modifier, and attribution). In certain examples, the model includes onlylocation derived reference-class constraints. Data constraints appearingin a location relationship derived model may result in the generation ofan anonymous data component to contain the actual data constraint, forexample.

An ontology may be defined as an organization of a knowledge domain thatis usually hierarchical and contains relevant entities (e.g., concepts)and their relationships. Concepts in controlled medical vocabularies(CMVs) may be organized into one or more ontologies, for example.

In the context of location management, a location ontology indicates ahierarchical organization of relation between various location types.Application of a particular ontology to a set of locations involvesdefining the locations as instances of various location types andcreating the relationship among them thereon, for example. In certainexamples, an ontology is a collection of tuples with members includingsource role, target role, and relationship type. An ontology uses onerelationship type, for example.

As shown in the example of FIG. 12, a directed acyclic graph 1200 may beused in an ontology. In certain examples, location management actionsmay restrict this using terminology services. A location relationshipvalidation service may validate that a location is not participating ina relationship where it has conflicting roles from one ontology toanother ontology, for example.

Location correlation is a quick way to find the locations for incomingmessages from another sending application, such as HL7 message systems.This system sends various patient information along with healthcaredelivery location(s) information. In order to identify a location basedon the relationship with other healthcare delivery locations, arelationship ontology, role(s) played, and location attributes of therequired location should be supplied.

As shown in FIG. 12, a location 1210 relates to one or more ontologies1220, 1230 through the directed graph 1200. Location 1210 includes aplurality of variants 1211-1217. Each location 1211-1217 relates to aparticular ontology 1220, 1230 which defines a role.

As depicted in the example of FIG. 12, nursing unit role 1233, criticalcare unit role 1235, teaching unit role 1237 are different variants of aunit role 1231, as defined by an ontology 1230. For a given location1212, 1213, a role is directed according to one or more relationships1232, 1234, 1236 in the unit role ontology 1230 (e.g., a location “is a”unit).

An additional hierarchy of roles 1221, 1223, 1225, 1227 in an “is partof” role ontology 1220 is illustrated by relationships 1222, 1224, 1226.Thus, as shown in the example of FIG. 12, a bed 1227 is part of 1226 aroom 1225, which is part of 1224 a unit 1223, which is part of 1222 afacility 1221. Each location 1211-1217 is associated with a particularpart of a facility 1221 as defined by the graph 1200.

The graph 1200 provides location relationship validation logic to helpensure that appropriate constraint(s) are applied on each locationrelationship. Using the directed graph 1200 for a given ontology 1220,1230, cyclic relationships can be prohibited. For example, Ontology(isPartOf) 1220 cannot have (Facility->Unit) as well as (Unit->Facility)as valid relations. Once a location plays a role in a given ontology, itcannot play any other role from the same ontology. An ontology can bechecked for a valid relation for a given source and target role, forexample. A Location Relationship can be identified where the locationplays a Role in this Ontology. Using the graph 1200, the location can beexamined to determine whether it plays a different role in the locationrelationship from the ontology. If yes, then the new locationrelationship may not be created. A clinical data repository, forexample, can be accessed to retrieve ancestor and child forparticipating location(s) for the given ontology. For each location, thelocation is checked to determine whether the location played any otherrole for that ontology either as source or target. If yes, an exceptionmay be thrown. In certain examples, self-relationship can be ignored forvalidation. If locations are already connected to each other, anexception can be thrown, for example.

FIG. 13 depicts an example location correlation identification (CID)schema 1300. The location CID schema 1300 facilitates expression andorganization of patient location data (e.g., assigned patient locationor APL data is mapped to a location CID). The schema 1300 provides anidentifier (CID) type, location, related location, and ontology for anassigned or other initial patient location, for example. Theseparameters can have associated attributes, for example. As illustratedin the example schema 1300, a location and/or related location can beassociated with a name, a role numerated correlation identifier (ECID),etc. An ontology can be associated with an ontology ECID, a relationshiptype ECID, etc. Information organized according to the location schema1300 is passed by a location correlator to a location service toretrieve a location instance identifier (IID). Thus, the location CID isan object carrying information of external and associated internalidentifiers. The location IID is an object including informationregarding an internal identifier.

In certain examples, as locations are part of the system and are createdupfront before the relationships being created, location correlationhappens on demand from interface engine. Each time a location iscorrelated, it is cached with a location correlator and provided ondemand, for example. On a cache miss, a CDR and/or other data store maybe queried to retrieve the relevant location via a frame manager. Theexample sequence diagram 1400 of FIG. 14 depicts interaction betweenvarious components for location correlation.

As shown in FIG. 14, interoperability services 1405 is used to create alocation CID 1410, which is passed to correlation services 1415 tocorrelate the CID with an IID 1420. The correlation services 1415 passesthe CID-IID correlation 1430 to a location correlation plugin 1425,which finds the location IID using the CID 1440. A find location message1450 is passed to a location service 1445, and an internal IID isresolved 1460 using a correlation store 1435 (e.g., a CDR). A locationmap can be updated 1470. The location service 1445 generates a locationquery 1480 and gets location 1490 from a frame manager 1455.

A location manager tool is an editor to import, export, and editlocations into a clinical knowledge platform. In certain examples, thetool makes use of location management services for get and set location,location relationship, and ontology definition, for example. The toolprovides an ability to search and view locations currently stored basedon location attribute(s), role(s) played by the location, and ontology,for example. The tool provides an ability to retrieve decedents andancestors for a selected location and ontology, for example. The toolprovides an ability to edit (e.g., create, read, update, and/or delete)a location, for example. The tool provides an ability to edit (e.g.,create, read, update, and/or delete) a location relationship, forexample. The tool provides an ability to generate a location importtemplate (e.g., in Microsoft Excel®) format for location and locationrelationship using ontology definition(s), for example. The toolprovides an ability to import locations, location relationship(s), etc.,using ontology definition(s) from a location import template based file,for example.

FIG. 15 illustrates an example location service application programminginterface (API) 1500. External applications 1510 can communicate withclient applications 1530 and a client library 1540, which work inconjunction with a content server 1570 to provide content arranged asclinical application functionality and data according to one or moredetailed clinical models and customized based on location.

As shown in FIG. 15, external applications 1510, such as a locationmanagement application 1511, clinical content gateway (CCG) 1512, etc.,access client applications 1530 via one or more service endpoints 1521,1522 implemented in a microkernel 1520. Client applications 1530 caninclude one or more server co-located applications 1531, such asinteroperability 1532, business services 1533, etc. The applications1532, 1533 access the client library 1540, which includes a framesmanager 1541, a content proxy 1542, a terminology proxy 1543, acorrelation client 1544, a security client 1545, etc. The client library1540 communicates with the content server 1570 via a pair of transportmanagers 1550, 1560. Thus, the library 1540 can store/update informationat a clinical data repository 1571, terminology 1572, content services1573, security 1574, etc.

Thus, using the services API, location information and other connecteddevice information 1511, 1512 can be provided to one or more clientapplications 1530 and can update a client library 1540 and contentserver 1570. The content server 1570 can use location relationshipinformation to update a data repository 1571, terminology 1572, contentservices 1573, security 1574, etc. Content and terminology forming aframe can be correlated based on location relationship information toprovide an application to a user, for example.

Certain examples allow a user/system to get a location instance and/orlist of location instance based upon location attributes and role orroles played by the location. Certain examples allow a user/system toget a location relationship and/or list of location relationshipinstance(s) for a specified location. Certain examples allow auser/system to get a location instance's decedent(s) and ancestor(s)based upon one and/or more specified ontology. Certain examples allow auser/system to get locations instance(s) stored in the systemirrespective of location relation information. Certain examples allow auser/system to get a device associated with a location. Certain examplesallow a user/system to get a location associated with a device. Certainexamples allow a user/system to get a location instance type. Certainexamples allow a user/system to get a location relationship instancetype. Certain examples allow a user/system to get location ontologiespublished by a controlled medical vocabulary services.

Certain examples allow a user/system to create, update, delete, and/orpersist a location instance. Certain examples allow a user/system tocreate, update, delete, and/or persist a set of location instances in abatch process with a capability to specify a restart, resume, and/orcontinue mode of batch process. Certain examples allow a user/system tocreate, update, delete, and/or persist a location relationship instancefor a specified tuple (e.g., source location instance, target locationinstance, location relationship instance, relationship ontology, etc.).This may be considered an atomic operation, for example. Certainexamples allow a user/system to create, update, delete, and/or persist aset of location relationship instances in a batch process withcapability to specify a restart, resume, and/or continue mode of batchprocess, where each location relationship is specified by a tuple (e.g.,source location instance, target location instance, locationrelationship instance, relationship ontology). Certain examples allow auser/system to validate a location relationship for a specified tuple(e.g., source location instance, target location instance, locationrelationship instance, relationship ontology).

FIG. 16 illustrates a flow diagram for an example method 1600 oflocation relationship management in a content-based clinical system. Incertain examples, a source location, a target location, a locationrelationship and a rule (e.g., an ontology definition) are provided.Location and location relationship can be updated independently and arelationship between two locations can be created and updatedindependently in runtime, for example. Clinical element models can beleveraged and customized by each of a plurality of healthcare deliveryorganizations to suit their specific needs without requiring changes insoftware.

At block 1610, one or more locations are loaded in a content-basedclinical information system as independent entities. For example, one ormore hospitals, clinics, departments in a hospital enterprise, etc., areloaded to configure/customize a content-based clinical application(e.g., a dashboard, etc.).

At block 1620, one or more location relations are created to connectlocations in a desired relationship ontology. At block 1630, onelocation is assigned a source role and another location is assigned atarget role. At block 1640, a relationship between the source and targetlocations is identified. Allowed relationships between source and targetroles are determined by a terminology definition of an ontology.Location relationship management services can validate conflicts ofroles between locations or by location, for example. At block 1650, thesource and target are stored in a location relationship object. At block1660, the location relationship object can be used to customize and/orotherwise configure one or more content items to provide clinicalfunctionality and/or data to a user. For example, a multi-patient viewof clinical information, made up of a plurality of content itemsorganized according to a plurality of detailed clinical models, can beconfigured for a particular location based on one or more locationrelationship objects associated with the models.

Thus, location relationships can be established as a healthcare deliveryorganization changes/grows/reorganizes without impacting an existingsoftware infrastructure of locations. Newly added relationships can bemade part of the system just in time or to be specific in real-timesubject to availability of terminology, for example.

While an example manner of implementing systems and methods have beenillustrated in the figures, one or more of the elements, processesand/or devices illustrated in the figures may be combined, divided,re-arranged, omitted, eliminated and/or implemented in any other way.Further, one or more components and/or systems may be implemented byhardware, software, firmware and/or any combination of hardware,software and/or firmware. Thus, for example, any of the examplecomponents and/or systems may be implemented by one or more circuit(s),programmable processor(s), application specific integrated circuit(s)(ASIC(s)), programmable logic device(s) (PLD(s)) and/or fieldprogrammable logic device(s) (FPLD(s)), etc. When any of the appendedclaims are read to cover a purely software and/or firmwareimplementation, at least one of the example components and/or systemsare hereby expressly defined to include a tangible medium such as amemory, DVD, Blu-ray, CD, etc., storing the software and/or firmware.Further still, any of the example systems may include one or moreelements, processes and/or devices in addition to, or instead of, thoseillustrated in the figures, and/or may include more than one of any orall of the illustrated elements, processes and devices.

The flow diagrams depicted in the figures are representative of machinereadable instructions that can be executed to implement exampleprocesses and/or systems described herein. The example processes may beperformed using a processor, a controller and/or any other suitableprocessing device. For example, the example processes may be implementedin coded instructions stored on a tangible medium such as a flashmemory, a read-only memory (ROM) and/or random-access memory (RAM)associated with a processor (e.g., the example processor 1712 discussedbelow in connection with FIG. 17). Alternatively, some or all of theexample processes may be implemented using any combination(s) ofapplication specific integrated circuit(s) (ASIC(s)), programmable logicdevice(s) (PLD(s)), field programmable logic device(s) (FPLD(s)),discrete logic, hardware, firmware, etc. Also, some or all of theexample processes may be implemented manually or as any combination(s)of any of the foregoing techniques, for example, any combination offirmware, software, discrete logic and/or hardware. Further, althoughthe example processes are described with reference to the figures, othermethods of implementing the processes of may be employed. For example,the order of execution of the blocks may be changed, and/or some of theblocks described may be changed, eliminated, sub-divided, or combined.Additionally, any or all of the example processes of may be performedsequentially and/or in parallel by, for example, separate processingthreads, processors, devices, discrete logic, circuits, etc.

FIG. 17 is a block diagram of an example processor system 1710 that maybe used to implement the systems, apparatus and methods describedherein. As shown in FIG. 17, the processor system 1710 includes aprocessor 1712 that is coupled to an interconnection bus 1714. Theprocessor 1712 may be any suitable processor, processing unit ormicroprocessor. Although not shown in FIG. 17, the system 1710 may be amulti-processor system and, thus, may include one or more additionalprocessors that are identical or similar to the processor 1712 and thatare communicatively coupled to the interconnection bus 1714.

The processor 1712 of FIG. 17 is coupled to a chipset 1718, whichincludes a memory controller 1720 and an input/output (I/O) controller1722. As is well known, a chipset typically provides I/O and memorymanagement functions as well as a plurality of general purpose and/orspecial purpose registers, timers, etc. that are accessible or used byone or more processors coupled to the chipset 1718. The memorycontroller 1720 performs functions that enable the processor 1712 (orprocessors if there are multiple processors) to access a system memory1724 and a mass storage memory 1725.

The system memory 1724 may include any desired type of volatile and/ornon-volatile memory such as, for example, static random access memory(SRAM), dynamic random access memory (DRAM), flash memory, read-onlymemory (ROM), etc. The mass storage memory 1725 may include any desiredtype of mass storage device including hard disk drives, optical drives,tape storage devices, etc.

The I/O controller 1722 performs functions that enable the processor1712 to communicate with peripheral input/output (I/O) devices 1726 and1728 and a network interface 1730 via an I/O bus 1732. The I/O devices1726 and 1728 may be any desired type of I/O device such as, forexample, a keyboard, a video display or monitor, a mouse, etc. Thenetwork interface 1730 may be, for example, an Ethernet device, anasynchronous transfer mode (ATM) device, an 802.11 device, a DSL modem,a cable modem, a cellular modem, etc. that enables the processor system1710 to communicate with another processor system.

While the memory controller 1720 and the I/O controller 1722 aredepicted in FIG. 17 as separate blocks within the chipset 1718, thefunctions performed by these blocks may be integrated within a singlesemiconductor circuit or may be implemented using two or more separateintegrated circuits.

Certain embodiments contemplate methods, systems and computer programproducts on any machine-readable media to implement functionalitydescribed above. Certain embodiments may be implemented using anexisting computer processor, or by a special purpose computer processorincorporated for this or another purpose or by a hardwired and/orfirmware system, for example.

Certain embodiments include computer-readable media for carrying orhaving computer-executable instructions or data structures storedthereon. Such computer-readable media may be any available media thatmay be accessed by a general purpose or special purpose computer orother machine with a processor. By way of example, suchcomputer-readable media may comprise RAM, ROM, PROM, EPROM, EEPROM,Flash, CD-ROM or other optical disk storage, magnetic disk storage orother magnetic storage devices, or any other medium which can be used tocarry or store desired program code in the form of computer-executableinstructions or data structures and which can be accessed by a generalpurpose or special purpose computer or other machine with a processor.Combinations of the above are also included within the scope ofcomputer-readable media. Computer-executable instructions comprise, forexample, instructions and data which cause a general purpose computer,special purpose computer, or special purpose processing machines toperform a certain function or group of functions.

Generally, computer-executable instructions include routines, programs,objects, components, data structures, etc., that perform particulartasks or implement particular abstract data types. Computer-executableinstructions, associated data structures, and program modules representexamples of program code for executing steps of certain methods andsystems disclosed herein. The particular sequence of such executableinstructions or associated data structures represent examples ofcorresponding acts for implementing the functions described in suchsteps.

Embodiments of the present invention may be practiced in a networkedenvironment using logical connections to one or more remote computershaving processors. Logical connections may include a local area network(LAN) and a wide area network (WAN) that are presented here by way ofexample and not limitation. Such networking environments are commonplacein office-wide or enterprise-wide computer networks, intranets and theInternet and may use a wide variety of different communicationprotocols. Those skilled in the art will appreciate that such networkcomputing environments will typically encompass many types of computersystem configurations, including personal computers, hand-held devices,multi-processor systems, microprocessor-based or programmable consumerelectronics, network PCs, minicomputers, mainframe computers, and thelike. Embodiments of the invention may also be practiced in distributedcomputing environments where tasks are performed by local and remoteprocessing devices that are linked (either by hardwired links, wirelesslinks, or by a combination of hardwired or wireless links) through acommunications network. In a distributed computing environment, programmodules may be located in both local and remote memory storage devices.

Although certain methods, apparatus, and articles of manufacture havebeen described herein, the scope of coverage of this patent is notlimited thereto. To the contrary, this patent covers all methods,apparatus, and articles of manufacture fairly falling within the scopeof the appended claims either literally or under the doctrine ofequivalents.

1. A content-based healthcare location management system comprising: acorrelation services manager to receive a location correlationidentifier and correlate the location correlation identifier with anassociated location instance identifier based on an ontology, thelocation instance identifier identifying an internal instance of thelocation correlation identifier to provide location informationaccording to a location schema; a location services manager to update alocation map using the location instance identifier, the locationservices manager to store the location instance identifier in a locationrelationship object based on at least one relationship associated withthe location instance identifier; and a frame manager to utilize thelocation relationship object to configure one or more content itemsforming a clinical application based on the location and relationshipidentified in the location relationship object.
 2. The system of claim1, wherein allowed relationships are determined by a terminologydefinition provided by the ontology.
 3. The system of claim 1, whereinthe location services manager is to validate a conflict of roles betweenlocations to identify a location relationship.
 4. The system of claim 1,wherein the ontology is to be represented by a directed acyclic graphnavigable to identify an ontology for a location.
 5. The system of claim4, wherein the graph includes a plurality of available ontologies forselection of a location relationship.
 6. The system of claim 5, whereinthe available ontologies include an “is a” ontology and an “is part of”ontology.
 7. The system of claim 1, wherein the frame manager is to usethe location relationship object to select one or more context variantsfor the one or more content items to form the clinical application forthe location.
 8. The system of claim 1, wherein a location is associatedwith a name and a role identifier, a related location is associated witha name and a role, and an ontology is associated with an ontologyidentifier and a relationship type identifier.
 9. A tangiblecomputer-readable storage medium including computer program code to beexecuted by a processor, the computer program code, when executed,implementing a content-based healthcare location management systemcomprising: a correlation services manager to receive a locationcorrelation identifier and correlate the location correlation identifierwith an associated location instance identifier based on an ontology,the location instance identifier identifying an internal instance of thelocation correlation identifier to provide location informationaccording to a location schema; a location services manager to update alocation map using the location instance identifier, the locationservices manager to store the location instance identifier in a locationrelationship object based on at least one relationship associated withthe location instance identifier; and a frame manager to utilize thelocation relationship object to configure one or more content itemsforming a clinical application based on the location and relationshipidentified in the location relationship object.
 10. Thecomputer-readable storage medium of claim 9, wherein allowedrelationships are determined by a terminology definition provided by theontology.
 11. The computer-readable storage medium of claim 9, whereinthe location services manager is to validate a conflict of roles betweenlocations to identify a location relationship.
 12. The computer-readablestorage medium of claim 9, wherein the ontology is to be represented bya directed acyclic graph navigable to identify an ontology for alocation.
 13. The computer-readable storage medium of claim 12, whereinthe graph includes a plurality of available ontologies for selection ofa location relationship.
 14. The computer-readable storage medium ofclaim 13, wherein the available ontologies include an “is a” ontologyand an “is part of” ontology.
 15. The computer-readable storage mediumof claim 9, wherein the frame manager is to use the locationrelationship object to select one or more context variants for the oneor more content items to form the clinical application for the location.16. The computer-readable storage medium of claim 9, wherein a locationis associated with a name and a role identifier, a related location isassociated with a name and a role, and an ontology is associated with anontology identifier and a relationship type identifier.
 17. A method forcontent-driven healthcare location relationship management, the methodcomprising: receiving one or more location identifiers for acontent-based clinical application; assigning one or more locations to asource role and a target role based on the one or more locationidentifiers and an ontology, the ontology including a plurality ofrelationship types; identifying a relationship between the source roleand the target role based on the one or more location identifiers andthe ontology; associating the source role and target role based on theidentified relationship; and utilizing the source role, target role, andidentified relationship to configure one or more content items formingthe content-based clinical application.
 18. The method of claim 17,further comprising storing the source role, the target role, and theidentified relationship in a location relationship object to be used toconfigure the one or more content items to form the content-basedclinical application.
 19. The method of claim 17, further comprisingcorrelating a location correlation identifier with an associatedlocation instance identifier based on the ontology to assign the one ormore locations to a source role and a target role.
 20. The method ofclaim 17, wherein identifying a relationship further comprisesdetermining one or more allowed relationships between the source roleand the target role based on a terminology definition provided by theontology.